*p < 0.001. Best known are Zoledronic Acid, Alendronate, Etidronate, Risedronate, Ibandronate (1). AHP amplitude was derived by finding the minimum value during a window between the peak of the action potential and the return to RMP. In 2010, the FDA even ordered on pack warnings. The test tray for the DMP task contained 4 food wells (2.5 cm in diameter). There was no apparent difference in the number of deaths from breast cancer or any cause; however survival benefits from aromatase inhibitors may become apparent after a longer period of follow-up. "At last the definitive book on a diet to fight cancer". Hormone therapy Hormones can stimulate some breast cancer cells to grow. They can cause side effects. Find out more here. Elevated levels of E2 are associated with reduced anxiety in women (Maeng and Milad, 2015); and while breast cancer survivors report increased depression and anxiety relative to women with no cancer history (Hansen et al., 2008), the impact of AI use on these symptoms is poorly understood. Long-term efficacy and safety of the use of . Brain tissues were analyzed for E2 content and HPC pyramidal cell physiology to investigate effects of letrozole on the brain. We use cookies to ensure that we give you the best experience on our website. Before the menopause, oestrogen is mainly produced in the ovaries. Of the 6 studies some were for normal BMD scores at the outset, while a second group were people with osteopenia at the outset of the trial. Unliketamoxifen and raloxifene, AIs tend to speed up bone thinning, which can lead to osteoporosis. 4. An unhealthy balance of aromatase in the body means that there are higher levels of testosterone and progesterone being converted into estrogen. A main effect of sex was observed for cortisol (F(1,12) = 5.71, p = 0.034, 2 = 0.32), with higher levels observed in females (35.22 12.85 g/mg Cr) than males (14.33 1.90 g/mg Cr, Hedge's g = 1.11). 3A). Letrozole had no effect on this behavior in females. They will weigh up the benefit of taking the drug for longer with other factors, such as any side effects you have and whether you want to have children. An experimenter blind to group assignment visually inspected each frame and removed those for which the spot meter was incorrectly placed (located off the face, or on the eye or mouth). Aromasin (exemestane) Arimidex (anastrozole) Femara (letrozole) For women with breast cancer, there is growing evidence aromatase inhibitors are more effective than tamoxifen, the drug traditionally used to prevent breast cancer recurrence. Although no correlation was observed, elevated HPC-E2 levels might also lead to reduced IE of CA1 neurons. Both endogenous E2 levels (Baker et al., 2015) and estrogen therapy (Freedman and Blacker, 2002) are associated with fewer hot flashes. You might have this on its own or with other hormone therapy drugs. Isnt that the same as you get with bisphosphonates? A second class, called aromatase inhibitors, blocks the production of estrogens. Women with pre-existing heart disease who take an AI may be at higher risk of having a heart problem. Breast Cancer Risk Factors You Cannot Change, Lifestyle-related Breast Cancer Risk Factors, Factors with Unclear Effects on Breast Cancer Risk, Disproven or Controversial Breast Cancer Risk Factors, Genetic Counseling and Testing for Breast Cancer Risk, Deciding Whether to Use Medicine to Reduce Breast Cancer Risk, Tamoxifen and Raloxifene for Lowering Breast Cancer Risk, Aromatase Inhibitors for Lowering Breast Cancer Risk, Preventive Surgery to Reduce Breast Cancer Risk, Breast Cancer Early Detection and Diagnosis, American Cancer Society Recommendations for the Early Detection of Breast Cancer. Should I Get Breast Reconstruction Surgery? The reduced IE of CA1 neurons is consistent with results reported in rats following short- (2 months) or long-term (5 months) ovarian hormone deprivation (via OVX) (Wu et al., 2011). Aromatase inhibitors were just as effective in women aged under 35, who have a higher risk of recurrence than older women. At this point you might be expecting me to say that Bisphosphonates somehow stimulate osteoblasts. JAMA. Letrozole (20 g/d, p.o.) No such correlation was observed in the vehicle-treated group (r(2) = 0.38, p = 0.623). ), then given an intracardial overdose of pentobarbital (50 mg/kg). Lets be clear. They combined data from four large-scale randomised controlled trials, which involved a total of over 7,000 women with early stage breast cancer, from countries across the world. In large studies, both anastrozole and exemestane have been shown to lower breast cancer risk in postmenopausal women who are at increased risk. Black represents twice rheobase. Aromatase inhibitors (AIs) aim to block the production of human oestrogen in your body in the first place. The hand was kept on the abdomen for a total of 20 min. Cuzick J, Sestak I, Forbes JF, et al. Letrozole treatment resulted in greater elevation in temperature across time for females only (p < 0.001). This means theres less oestrogen in the body to help breast cancer cells to grow. Breast Cancer Now is a company limited by guarantee registered in England (9347608) and a charity registered in England and Wales (1160558), Scotland (SC045584) and Isle of Man (1200). The symptoms include hot flushes, sweating and mood swings. Sharma P. Selective estrogen receptor modulators and aromatase inhibitors for breast cancer prevention. The surgeon makes a number of small cuts into your tummy (abdomen). The currently established . Your doctor might recommend you have tamoxifen to: You are likelyto have tamoxifen for 5 years. You have check ups with your doctor during hormone therapy treatment to see if your canceris getting smaller. 2. We'd love to keep in touch about news, events and how you can get involved. Four weeks of letrozole treatment (20 g/d, p.o.) Thermoregulation, HPC neural activity, and spatial working memory were all compromised by treatment. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e . There was no further benefit, or loss of benefit, between five to ten years. Your doctor mightchange you to a different type of hormone treatment if your cancer starts growing again. However, some people may get on better with one drug than another. No other comparisons were significant. While no changes in hypothalamic E2 were observed, thermoregulation was disrupted by letrozole in females only, indicating some impact on hypothalamic activity. These effects may be due to synaptic changes in the HPC, as estradiol (E2)-synthesis inhibition reduces the number of spine synapses in the HPC in vitro (Kretz et al., 2004) and in vivo in OVX mice (Zhou et al., 2010), potentially by destabilizing the spine cytoskeleton (Vierk et al., 2014). C, A larger reduction in performance is associated with higher E2 levels in the hippocampus within the letrozole group (r = 0.87, p = 0.058). Which aromatase inhibitor causes less side effects? This side effect can be serious enough to cause some women to stop taking the drugs. Similar levels of T were observed across treatment group and sex, with no significant main effect or interaction (sex: F(1,12) = 1.14, p = 0.307, 2 = 0.09; drug: F(1,12) = 0.22, p = 0.645, 2 = 0.02; interaction: F(1,12) = 1.82, p = 0.20, 2 = 0.13; Fig. AddingBisphosphonatestostop bone breakdown when they block mineral resorption, isnt this just doubling the problem? Both treatment groups were matched based on age and sex. Recording pipettes were pulled from borosilicate glass (47 MOhm) using a PC-10 puller (Narishige) and filled with internal solution containing the following (in mm): 120 K-gluconate, 20 KCl, 0.1 CaCl2, 5 HEPES, 5 EGTA, 3 MgATP, 0.5 Na-GTP, and 10 phosphocreatine. The Rainbow Diet and how it can help you beat cancer. Well, thats what the ABH people say. Experimental studies in appropriate animal models are needed to complement those in humans as they offer the advantage of including appropriate control groups in the absence of the confounds listed above. And this apparent flaw is well researched. Marmosets were fed Mazuri Callitrichid High Fiber Diet 5M16 (Purina Mills) supplemented with a variety of fresh fruit, nuts, and mealworms. There was no further benefit, or loss of benefit, between five to ten years. This is called adjuvant treatment. Some studies have also reported increased T following AI use (Taylor et al., 2017), and so T levels were also assessed. You have them once every 4 weeks. The camera provided a video of the face along with a measurement of temperature (in F) on the crosshair location. People with osteoporosis are more likely to have broken bones. Volume 37, Issue 5, Pages 423 438. They work by stopping oestrogen being made in body fat and muscle after the menopause. Adjuvant Endocrine Therapy for Women With Hormone Receptor-Positive Breast Cancer: ASCO Clinical Practice Guideline Focused Update The mean accuracy for each phase (baseline/treatment) was the dependent variable. Each woman had received an ovarian suppressing treatment. Urinary hormone levels were collected from a mixed-sex sample of marmosets, who received either letrozole (males: n = 4; females: n = 3) or vehicle (males: n = 4; females: n = 4). In the morning, letrozole-treated marmosets spent more time in agitated locomotion, a sensitive marker for anxiety (Bowell, 2010). 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This is also a type of ovarian ablation. IE of CA1 pyramidal neurons is attenuated by 4 weeks of letrozole treatment (20 g/d, p.o.). Are plant-based diets good for your health and the planet? In addition, they were randomly allocated to take an aromatase inhibitor or tamoxifen for three or five years. 3B). You have this operation as keyhole surgery. Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): An international, double-blind, randomised placebo-controlled trial. Some vigilant behaviors were increased by letrozole treatment, although time of day appears to have influenced the pattern of results. Click 'Find out more' for information on how to change your cookie settings. All the treatments that stop your ovaries working give you an early menopause, but this might be temporary with goserelin. They obviously havent read the on pack FDA warning. See what you can do to cope with breast cancer andtreatment, and the effect it has on yourlife and relationships. Remaining regions were unaffected by drug treatment. Each animal was sedated with ketamine (10 mg/kg, i.m. They were gonadectomized (GDX) 3 years before the start of the experiment. It is calledlaparoscopic oophorectomy and you have it under general anaesthetic . For example, goserelin (Zoladex) and leuprorelin (Prostap, Lutrate). All statistical analyses were conducted using the SPSS software (IBM), with Type I error rate set at = 0.05, and results are expressed as mean standard error of the mean (SEM) in Figures 15. Hormone treatments lower the levels of oestrogen orprogesterone in the body, or block their effects. Aromatase inhibitors are hormone therapy drugs used to treat hormone receptor-positive breast cancer. The temperature values obtained from each remaining frame (122 60) were averaged in 1 min bins for each animal. The structural and functional organization of the marmoset brain is comparable with the rhesus or human brain (Chaplin et al., 2013). Resting membrane potential (RMP) and spontaneous spiking activity were measured under current-clamp configuration with zero-injected current. A statistically significant decrease in performance was observed in the letrozole-treated group (t(4) = 3.66, p = 0.022, Hedge's g = 1.16; Performance change: males = 4.42 2.18%; females = 10 0%), whereas no change was observed in the vehicle-treated group (t(3) = 0.40, p = 0.71, Hedge's g = 0.34, Fig. The experimenter focused the camera on the marmoset's face using the crosshair of the camera as a guide. During the test phase, the monkey must displace the token located in the same position to obtain the reward. A side effect of aromastase inhibitors and goserelin is bone thinning (osteoporosis) or weakening. Approved by the Medical Board. Your doctor checks your cancer cells for these receptors when you are diagnosed. 2C). Find out about breast cancer, including symptoms, diagnosis, treatment, survival, and how to cope with the effects on your life and relationships. If you have been offered an aromatase inhibitor, your specialist will explain why they have recommended that particular drug. Group assignment was pseudorandom, with one member of each pair assigned to letrozole and the other to vehicle. However, the frequency of bone fractures was low overall, and this can be mitigated through treatment with drugs that help to strengthen bones (bisphosphonates). Together, these results suggest that 4 weeks of letrozole treatment mimics the detrimental effects of long-term ovarian hormone deprivation on IE and spontaneous activity. At the brain level, we measured both E2 content in several brain regions and HPC neuron physiology. Urine was collected using a disposable transfer pipette and placed in a microcentrifuge tube, then spun for 5 min at 14,000 rpm. Behavioral, spatial memory performance and facial temperature measures were collected to address whether continuous administration of oral letrozole to middle-aged GDX marmosets mimics the CNS symptoms reported by women taking AIs. It is most common to have hormone therapy after surgery for breast cancer. H J Burstein and others Our team is made up of doctors andoncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing. FI curves were compared and revealed a significant interaction between treatment and injected current (F(4,100) = 2.95, p = 0.024, 2 = 0.11), with reduced firing frequency in letrozole-treated cells following currents of 20 pA (t(27) = 2.69, p = 0.012, letrozole = 1.47 0.54 Hz, vehicle = 4.46 1.00 Hz, Hedge's g = 1.00) and 30 pA (t(27) = 2.25, p = 0.013, letrozole = 2.43 0.62 Hz, vehicle = 5.57 1.03 Hz, Hedge's g = 0.98; Fig. The aromatase inhibitors block estrogen synthesis and are used as therapy of estrogen receptor positive breast cancer, usually after resection and as a first line treatment or after failure of tamoxifen (another antiestrogen that acts by blocking the estrogen receptor). At our National Cancer Information Center trained Cancer Information Specialists can answer questions 24 hours a day, every day of the year to empower you with accurate, up-to-date information to help you make educated health decisions. As the hypothalamus, and in particular the POA, contains thermosensitive neurons that play a role in thermoregulation (for review, see Rance et al., 2013), it is possible that aromatase inhibition impairs thermoregulation via mechanisms that involve E2 in this structure. We show that AI-treated male and female marmosets exhibit behavioral changes consistent with these CNS symptoms, as well as elevated hippocampal estradiol and compromised hippocampal physiology. Some of the topics we can assist with include: For medical questions, we encourage you to review our information with your doctor. All experimenters were blind to group membership. The test tray is then concealed from view for 1 s, during which time the reward is replaced and the token is repositioned over the sample location along with an identical token placed over a different well. As the -ase in its name infers, aromatase is an enzyme. The relatively small sample, the broad age range, and the use of a single cognitive task limit the conclusions that can be drawn from our results. Marmosets were administered the spatial working memory test (i.e., delayed matching-to-position task [DMP]) daily for 5 d before the start of the drug treatment, and again during the fourth week of treatment. Four weeks of an oral AI (letrozole; 20 g/d) has adverse effects on multiple behavioral, neuronal, and physiological outcomes in GDX marmosets >5 years old. RMP was calculated as the average subthreshold membrane voltage during spontaneous recordings. Your doctor will tell you exactly how long to take your treatment for. You have hormone therapy for 5 years or more. Mean values obtained in each group are presented in g/mg Cr. An interaction was observed for time spent in inactive alert in the afternoon (F(1,12) = 10.90, p = 0.006, partial 2 = 0.48). The extraction process began with three rounds of ether extraction. 1. Hormone therapy works by either lowering the amount of hormones in the body or by blocking them getting to breast cancer cells. Estrogens are synthesized by the conversion of testosterone (T) through the enzyme aromatase. Group assignment was pseudorandom, with one member of each pair assigned to letrozole and the other to vehicle. The remaining samples were placed in centrifuge tubes and stored in a 80C freezer. 2023 To investigate whether daily letrozole administration impacts anxiety-like behavior in GDX marmosets, spontaneous behaviors of each marmoset pair were recorded daily for 5 d for 10 min alternating between 9:00 A.M. to 10:00 A.M. and 4:00 P.M. to 5:00 P.M. But, if you're close to the age at which your menopause would naturally start, your periods might not start again. B, Mean accuracy of each group during the baseline and treatment week. Temperature change was similar across the two treatment groups in the males (vehicle = 2.20% change in F 1.75 letrozole = 1.94% change in F 0.48; Hedge's g = 0.09). Effects of estradiol on the thermoneutral zone and core temperature in ovariectomized rats, Male aromatase-knockout mice exhibit normal levels of activity, anxiety, and depressive-like symptomatology, The pharmacokinetics of letrozole in brain and brain tumor in rats with orthotopically implanted C6 glioma, assessed using intracerebral microdialysis, Magnitude of the impact of hot flashes on sleep in perimenopausal women, Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors, Effects of transdermal testosterone gel or aromatase inhibitor on prostate volume in older men, Control of aromatase in hippocampal neurons, Laboratory and ambulatory monitoring of menopausal hot flashes, Estrogen raises the sweating threshold in postmenopausal women with hot flashes, Estradiol and hippocampal memory in female and male rodents, Impact of adjuvant endocrine therapy on quality of life and symptoms: observational data over 12 months from the mind-body study, The middle-aged ovariectomized marmoset (, Inhibition of estradiol synthesis impairs fear extinction in male rats, Response of ER and aromatase expression in the monkey hippocampal formation to ovariectomy and menopause, Remote long-term registrations of sleepwake rhythms, core body temperature and activity in marmoset monkeys, Adult male rat hippocampus synthesizes estradiol from pregnenolone by cytochromes P45017 and P450 aromatase localized in neurons, Neurokinin B administration induces hot flushes in women, Management of hot flashes in women with breast cancer, Sex differences in behavioral and neurochemical effects of gonadectomy and aromatase inhibition in rats, Hippocampal synapses depend on hippocampal estrogen synthesis, Oestradiol modulation of cognition in adult female marmosets, Endocrine treatment-associated cognitive impairments in breast cancer survivors: evidence from published studies, Mechanisms of aromatase inhibitor resistance, Sex differences in anxiety disorders: interactions between fear, stress, and gonadal hormones, Impaired spatial reference memory in aromatase-deficient (ArKO) mice, Aromatization of androstenedione by the anterior hypothalamus of adult male and female rats, Multiple functions of aromatase and the active site structure: aromatase is the placental estrogen 2-hydroxylase, Modulation of body temperature and LH secretion by hypothalamic KNDy (kisspeptin, neurokinin B and dynorphin) neurons: a novel hypothesis on the mechanism of hot flushes, Modeling hot flushes and quality of life in breast cancer survivors, The distribution and regulation of aromatase in the mammalian brain: from mice to monkeys, Endocrine effects of adjuvant letrozole compared with tamoxifen in hormone-responsive postmenopausal patients with early breast cancer: the HOBOE trial, Distribution and regulation of telencephalic aromatase expression in the zebra finch revealed with a specific antibody, Individual differences in behavioral and cardiovascular reactivity to emotive stimuli and their relationship to cognitive flexibility in a primate model of trait anxiety, Subjective and objective measures of hot flashes, Measurement of hot flashes by sternal skin conductance and subjective hot flash report in Puebla, Mexico, Estradiol acutely potentiates hippocampal excitatory synaptic transmission through a presynaptic mechanism, Performance of the marmoset monkey on computerized tasks of attention and working memory, Estrogen replacement in middle-aged women: thermoregulatory responses to exercise in the heat, The marmoset as a model of aging and brain disease, Cognition in female rats after blocking conversion of androgens to estrogens, Inhibition of location estrogen synthesis in the hippocampus impairs hippocampal memory consolidation in ovariectomized female mice, Brain estrogen production and the encoding of recent experience, Aromatase inhibition abolishes LTP generation in female but not in male mice, Hippocampal estradiol synthesis and its significance for hippocampal synaptic stability in male and female animals, Steroidogenic factor-1 expression in marmoset and rat hippocampus: co-localization with StAR and aromatase, Long-term and short-term electrophysiological effects of estrogen on the synaptic properties of hippocampal CA1 neurons, Ovarian hormone deficiency reduces intrinsic excitability and abolishes acute estrogen sensitivity in hippocampal CA1 pyramidal neurons, Sustained performance by common marmosets in a delayed matching to position task with variable stimulus presentations, Aromatase inhibitors induce spine synapse loss in the hippocampus of ovariectomized mice, Functional role of estrogen metabolism in target cells: review and perspectives, Basolateral amygdala astrocytes are engaged by the acquisition and expression of a contextual fear memory, Restoration of sleep and circadian behavior by autophagy modulation in Huntingtons disease, The stria vascularis in mice and humans is an early site of age-related cochlear degeneration, macrophage dysfunction, and inflammation, Learning a Model of Shape Selectivity in V4 Cells Reveals Shape Encoding Mechanisms in the Brain, A Fluid Self-Concept: How the Brain Maintains Coherence and Positivity across an Interconnected Self-Concept While Incorporating Social Feedback, A Texture Statistics Encoding Model Reveals Hierarchical Feature Selectivity across Human Visual Cortex, Visit Society for Neuroscience on Facebook, Follow Society for Neuroscience on Twitter, Follow Society for Neuroscience on LinkedIn, Visit Society for Neuroscience on Youtube, Erratum: Gervais et al., Adverse Effects of Aromatase Inhibition on the Brain and Behavior in a Nonhuman Primate - March 28, 2023, Correspondence should be addressed to Nicole J. Gervais at. Aromatase inhibitors stop this enzyme from working. Oncologists think that Bisphosphonatesstop bone fractures in cases of Osteoporosis. Aromatase inhibitors are a class of medicines that work by blocking the enzyme aromatase, the enzyme that converts androgens into estrogen. Dashed horizontal lines indicate the average background E2 levels obtained by EIA for assay blanks. Prolonged use of letrozole might also lead to the observed findings through escaped inhibition. ADRs can occur too its where you need an Artificial Disc Replacement in your back because of brittle bones. "Learn how to take control of your oestrogen levels", A recipe book by Chris Woollams and Barbara Cox. Representative images obtained 5 min and 20 min into the challenge are shown, along with the temperature reading. Free T (B) and cortisol (C) levels were not different across treatment groups but were higher in females than males. This is to check your bone strength (bone density). For example, they might be a reasonable option for women who have an increased risk of blood clots and therefore should not take tamoxifen or raloxifene. Data were analyzed offline using custom scripts written in Igor Pro 6 (Wavemetrics). F Cardoso and others Because AIs are administered both orally, at low dose and continuously in women, one prediction from our study is that they induce elevated HPC E2 levels, an intriguing possibility that will require empirical validation. A main effect of treatment was observed for E2 (F(1,12) = 24.69, p = 0.0003, 2 = 0.67; Fig. Result? Brain regions analyzed were as follows: (A) hippocampus, (B) hypothalamus, and (C) frontal cortex. Body Image and Sexuality After Breast Cancer, Menopausal Hormone Therapy After Breast Cancer, Radial Scars and Other Non-cancerous Breast Conditions, Infographic: 7 Things to Know About Getting a Mammogram, Text Alternative for 7 Things to Know About Getting a Mammogram Infographic, Frequently Asked Questions About the American Cancer Societys Breast Cancer Screening Guideline. Error bars indicate SEM. Nevertheless, we demonstrated that 4 weeks of oral administration of the AI letrozole at a dose comparable with what is used by women effectively reduces peripheral levels of E2 but leads to a compensatory increase in E2 levels in the HPC. In addition, we cannot rule out that the observed sex difference resulted from an interaction between the potential stress associated with the thermal challenge and sex. This activity describes the indications, action, and contraindications for anastrozole as a valuable agent in managing advanced hormone-receptive breast cancer. Dried samples were resuspended in 0.1 m PB, followed by solid-phase extraction, which consisted of eluting the resuspended samples through high performance extraction disk cartridges lined with C18 (3M) under vacuum pressure (7 in/Hg). Predictors of treatment discontinuation are not clearly defined. Learn about aromatase inhibitors and other hormone therapies for metastatic breast cancer. You take theseas a tablet once a day, usually for at least 5 years. 1A), with lower levels observed in the letrozole-treated group (0.03 0.004 g/mg Cr) compared with the vehicle group (0.33 0.07 g/mg Cr; Hedge's g = 2.17). The DMP task requires monkeys to discriminate between two locations and displace a token that previously concealed a food reward (see Fig. Extending such therapy beyond 5 years offers further protection but has additional side effects. Use of endocrine therapy for breast cancer risk reduction: ASCO clinical practice guideline update. Women who are still having periods (are pre menopausal) and women who have had their menopause (post menopausal) cantake tamoxifen. Both treatment groups were matched based on age and sex. Over a median follow-up period of eight years, the researchers looked for differences between the two groups in breast cancer recurrence, and deaths from breast cancer or any cause. Featured: Have cancer and want to quit smoking? 4B), with greater change in facial temperature in the letrozole group (vehicle = 0.54% change in F 0.05 letrozole = 4.45% change in F 1.46; Hedge's g = 1.55). 5BD). The present results suggest that higher HPC-E2 levels are related to greater performance deficits on the DMP task in the letrozole group, which is in contradiction with studies using intracerebral administration of AIs, finding impaired spatial learning and memory (Tuscher et al., 2016; Bailey et al., 2017) following reduced E2 levels in the HPC. Before I give you the evidence-based conclusions I just want to tell you that in bone health there is something called BMD Bone Mineral Density. Following menopause, aromatase in . They're also called hormone therapy or endocrine therapy. Aromatase inhibitors (AIs) are approved for use in both early- and advanced-stage breast cancer in postmenopausal women. Tax ID Number: 13-1788491. 2021. You might also have calcium and vitamin D supplements to help reduce the effect on your bones. These hormones can stimulate the growth of some breast cancer cells. We do not retain these email addresses. Lets look at a meta-review of different Bisphosphonates, following having AI drugs prescribed for women withbreast cancer.